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Endrocrine & Reproduction II Exam #1 > Normal and Abnormal Breast Exam > Flashcards

Normal and Abnormal Breast Exam Flashcards

1
Q

Where does most of the glandular tissue exist in the female breast?

A

The upper outer quadrants

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2
Q

What are the 2 most common routes for metastasis in the breast?

A

Ipsilateral lymph node and Internal mammary nodes

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3
Q

What are the 4 congenital anomalies of the breast?

A

Absence of the breast

Accessory breast tissue along the milk line

Extra nipples (polythelia)

Accessory breast (polymastia)

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4
Q

What are the 2 most common breast complaints?

A

Breast pain and apparent mass

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5
Q

What are 2 risk factors for development of breast cancer (in terms of onset/cessation of menarche/menses)?

A

Early menarche (12> y/o)

Late cessation of menses (>55 y/o)

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6
Q

What are some common risks for breast cancer? (8)

A 
Never breast fed
Recent and long-tern use of oral-contraceptives
Post-menopausal obesity
H/O endometrial or ovarian cancer
Alcohol consumption
Increased height
High socioeconomic status
Ashkenazi Jewish heritage
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7
Q

Palpable breast masses always get…

A

A biopsy (FNA/core/excisional)

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8
Q

Mammography is able to detect… (2)

A

Lesions about 2 years before they become palpable

Inapparent masses of <1 cm

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9
Q

At what age is mammography best?

A

> 40 y/o

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10
Q

What is breast ultrasonography most useful in evaluating?

What age group is most appropriate?

A

Inconclusive mammogram findings

Young women (<40 y/o) and others with dense breast tissue

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11
Q

What are 2 unique functions of breast ultrasonography?

A

Allows for differentiation between cystic and solid lesions

Guidance when performing a core needle biopsy

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12
Q

Under which scenarios (3) would a breast MRI be appropriate?

A

In adjunct with mammography for suspicious masses

Post-cancer diagnosis for staging evaluation

Women at risk for breast cancer (BRCA mutations, etc.)

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13
Q

FNAB is useful for:

A

Determining solid vs. cystic masses

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14
Q

What kinds of fluids from FNAB would indicate mammography/US?

A

Bloody fluid should be sent for cytology and followed with mammography/US

Clear fluid does not require further evaluation

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15
Q

What should be done after FNA with cystic masses?

A

Return to clinical breast exam in 4-6 mo. if cyst completely disappears with aspiration

If cyst reappears or does not fully resolve, diagnostic mammogram/US and biopsy are indicated

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16
Q

How many samples are needed in a core biopsy? How big should they be?

A

3-6 samples about 2 cm. long

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17
Q

When does cyclic mastalgia begin and end?

A

It begins at the luteal phase and ends after onset of menses

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18
Q

What is non-cyclic mastalgia?

A

It is not associated with the menstrual cycle and may include tumors, mastitis or cysts or with some medicines

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19
Q

What medications are associated with non-cyclic mastalgia? (3)

A

Anti-depressants

Anti-hypertensives

Hormonal meds (OCPs)

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20
Q

What are 3 extra-mammary causes of mastalgia?

A

Chest wall trauma

Shingles

Fibromyalgia

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21
Q

What is the only FDA approved treatment for mastalgia?

What are its side effects?

A

Danazol

Menstrual irregularities, benign intracranial HTN, changes in blood sugar, deepening of voice, abnormal hair growth, weight gain

22
Q

What 2 drugs may help in mastalgia?

A

Oral contraceptives

Depo Provera

23
Q

What lifestyle modifications may help mastalgia symptoms? (6)

A 
Properly fitting bra
Weight loss
Exercise
Decreased caffeine intake
Vit. E supplementation
Evening of primrose oil
24
Q

Nipple discharge is usually _______, but can be a sign of _______ or _______

A

Usually benign, but can be a sign of an endocrine disorder or cancer

25
Q

Non-spontaneous, non-bloody (clear, green or yellow) and bilateral discharge is most consistent with…

A

Fibrocystic changes or ductal ectasia

26
Q

What could a milky discharge be a sign of? In which patients is it common?

A

Common with childbearing, but can indicate hyperprolactinemia, hypothyroidism or medication-related response (oral contraceptives or psychotropics)

27
Q

Bloody nipple discharge should be considered…

A

Cancer until proven otherwise

28
Q

What is on the DDx for bloody nipple discharge?

How is it evaluated?

A
  1. Cancer: intraductal carcinoma or ductal carcinoma
  2. Benign intraductal papilloma

Breast ductography

29
Q

What are the 3 categories of breast masses and what is the RR of developing cancer?

A

Non-proliferative: 1.0

Proliferative without atypia: 1.5-2.0

Proliferative with atypia: 8.0-10.0

30
Q

What are fibrocystic changes?

A

A spectrum of changes observed in the normal breast present in about 50% of women: lobules of breast dilate and form cysts and cysts rupture and result in scarring and inflammation

31
Q

What is adenosis?

A

Lobular growth with increased number of glands

32
Q

What causes lactational adenomas?

A

A hormonal response

33
Q

What are the most common benign tumor of the female breast?

A

Fibroadenoma

34
Q

At what age do fibroadenomas develop?

What is their gross appearance?

How big are they usually?

Can they become malignant?

A

Late teens to early 20s

Solid, rubbery, mobile and typically solitary

Usually 2-4 cm but can be as big as 15 cm

Yes - complex cellular lesions have an increased risk

35
Q

What is a galactocele?

When does it occur?

What is a complication?

What is the treatment?

A

A cystic dilation of duct filled with milky fluid

Occurs near time of lactation

Secondary infection that causes acute mastitis

Typically can be needle aspirated

36
Q

What is sclerosing adenosis?

A

Increased fibrosis within the breast lobules

37
Q

What are complex sclerosing lesions (radial scars)?

A

Tubules trapped within a dense stroma surrounded by radiating arms of epithelium

38
Q

What are papillomas?

What ages do they appear?

What kind of discharge may result?

A

Intraductal growths

30-50 y/o

Serous or serosanguinous discharge

39
Q

Which 4 lesions are considered “proliferative without atypia”?

A

Epithelial hyperplasia

Sclerosing adenosis

Complex sclerosing lesions (radial scars)

Papillomas

40
Q

Is Lobular CIS (LCIS) pre-malignant?

A

No, but it is a risk factor

41
Q

What is Ductal CIS?

A

Ducts filled with atypical epithelium which is an increased risk for developing invasive disease or reoccurance of DCIS

42
Q

How are LCIS and DCIS treated usually?

A

Excision and followed with selective estrogen receptor modulators

43
Q

What is the lifetime risk for developing breast cancer vs. the lifetime risk of dying from it?

A

Developing breast cancer - 1:8

Lifetime - 1:28

44
Q

What are the risks of developing cancers in women with a BRCA1 and BRCA2 mutation?

A

BRCA1: 50% of early onset breast cancers and 90% of hereditary ovarian cancers

BRCA2: 35% of early onset breast cancers and a lower risk of ovarian cancer

45
Q

In which patients is the Gail model not as useful?

In which patients might it be falsely elevated?

Women with high risk are counseled to explore what options?

A

Less useful in second degree relatives with breast cancer

Falsely elevated in patients with multiple breast biopsies

Women considered high risk (5-year risk of >1.7%) counseled on prophylactic therapy (chemoprevention, mastectomy, oophorectomy)

46
Q

What is the most common to least common types of breast cancer?

A
  1. Ductal (70-80%)
    - most common in women in 50s and spread to regional LNs
  2. Lobular (5-15%)
    - more likely to be multifocal and/or bilateral
  3. Nipple - Paget’s disease presenting as superficial skin lesions (3%)
  4. Inflammatory breast cancer (1-4%)
    - swelling, redness and induration of nearby tissue
47
Q

What should be used in addition to staging to determine the prognosis of breast cancers?

A

Receptor status

48
Q

Which oncogenes signify a worse prognosis? How common is it?

A

HER2/neu (20-30% of invasive cancers)

49
Q

What therapy is used in all stages of breast cancer?

A

Adjuvant therapy - reduces reoccurence by 1/3 and reduces risk of death by 30%

50
Q

Breast cancer follow-up schedule for..

First 2 years post diagnosis
After first 2 years

When do most reoccurences happen?

A

First 2 years post diagnosis: every 3-6 mo.
After first 2 years: annually

Within first 5 years after treatment

Endrocrine & Reproduction II Exam #1 (17 decks)

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